Category Archives: caregiving and the holidays

Gift ideas for your senior loved one

As the holidays approach, purchasing a gift for an individual with hugs-079dementia can become difficult. Please be sure to keep in mind where the individual is living as to what type of gifts will be appropriate. If they are in a facility be sure to ask the staff there what is best. Below is a list of gift suggestions that can assist family members and friends with this task: Electric coffee or tea pots that turn off after a short period of time

  1. Large desk calendars to mount on the wall
  2. Medication holders—with timer to indicate time to take
  3. Photo albums with names and dates next to each picture
  4. Registration in the Medic Alert®/Safe Return Program®
  5. Simple-to-manage clothing (tube socks, easy on sweatshirts, tennis shoes with Velcro closings)
  6. Gift certificates for hair cuts and manicures
  7. Older music (especially music from the 30’s and 40’s)
  8. Tapes of sermons or church services
  9. Cuddly stuffed animals
  10. Tickets to take them to a musical event or circus
  11. Trip to a shopping mall and lunch
  12. Visit to the local senior center to participate in activities
  13. Bird feeders
  14. Tapes of bird songs
  15. Gift certificates to adult day services
  16. Hugs, Hugs, Hugs
  17. Short visits often

~Alz. Assoc.

Raleigh Geriatric Care Management, www.rgcmgmt.com, 919-803-8025

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Holiday Help: Relieving Caregivers’ Stress

by, Cheryl Smith, Caregiver.com

Who doesn’t feel overwhelmed sometimes by the bustle of the holiday season? Add to that the responsibility of caring for a frail elderly loved one, and burnout is simply a concept waiting to become reality. But wait. If you’re one of the 22 million households providing care for a family member or friend, there is hope. Stress doesn’t have to take the starring role in your family festivities this year.

If you’re like the increasing number of Americans who are trying to offer a sense of dignity to your parent(s), include them in seasonal events and help them stay in their own home, safety is your number one priority.

Most accidents happen at home in unsupervised situations. This season, enlist the help of older children or a spouse, playing games with (Great) Grandma and (Great) Grandpa while you change beds, do the laundry and other chores. Instead of decorating to the hilt, keep holiday décor simple. Eliminate the need for extension cords on the floor and “declutter” your notion of decoration: use colorful paper garlands strung high instead of breakable objects placed within reach. Remove anything a child or a frail elderly person may stumble over. Replace candles with bright centerpieces of fruit or flowers. Keep candy to an absolute minimum to prevent sugar highs and lows.

With the emphasis on “good cheer” during the month of December, the options are many. But don’t wear yourself out trying to make the holidays “happen” for everyone. If you don’t get yourself in a situation where you “overdo” you’ll be more alert to hazards—even emotional ones. Holidays bring emotions to the surface because they hold the most intense memories for your loved ones, and some may not be pleasant. You may find that tears fall for no apparent reason, or that a frail elderly parent suddenly seems gruff or annoyed just when you think everything is fine. Sometimes, the emotional stress of the season makes a frail aging parent seem distant, just when you want to draw them close. We never know what precipitates these reactions; we only have to deal with them. That’s not an easy task, but first and foremost, a caregiver must keep her own emotional balance.

Set a few guidelines as to what you expect from yourself. From the very start, set your intention to be positive during the holidays, and to respond with calmness to upsetting scenarios. Sure, things may come to the boiling point at times, but the resolve not to react in like manner will bring the most effective results. People don’t intend to be grumpy, distant or to give you a hard time. These behaviors may simply be a way of asking for help. The best way to give it is by remaining patient, offering consistent encouragement, and setting safe boundaries.

You cannot make everyone happy at all times, but you can take responsibility for your own emotional highs and lows. Preserve a few moments each day all for yourself. Take a half-hour break while your children entertain the frail elderly with Christmas music from the 30s, 40s and 50s or interview their grandparents about favorite holiday memories. You might enlist the services of a home-help organization to do some of the household chores while you go grocery shopping or simply take a walk. Professional caregivers can also help alert you to signs of stress or special needs that you might not recognize on a day-to-day basis, curtailing accidents or emotional spills.

Keep in mind that a frail person may tire more easily during the holiday season, need more sleep as the days grow shorter, and also need their own “space.” Ask for their help; ask them to let you know what they need and how they want to celebrate. Their answers may surprise you. Above all, an older frail person may crave our respect and our admiration. When we praise the good things they’ve accomplished in life, make certain they know that we appreciate their legacy, and tell them we’re happy they’re with us, things will be a lot easier. If they seem only to complain more, well, just grease the wheel with a little praise for yourself. Send positive messages to yourself out loud and mix in a few more affirmations for them.

The holidays are a great time to slow down instead of speed up. Think about all the things you can let remain undone instead of all the things you need to do. Give yourself a challenge to match the tempo of your frail elderly relatives or friends, and see if you don’t enjoy the season more. And after all, isn’t that what the holiday season is all about?

Contact Raleigh Geriatric Care Management for a 15 minute no cost telephonic consultation:  919-803-8025.  www.rgcmgmt.com

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Moving in With Family: Issues to Consider

_77183535_77183027~Helen Hunter

Too often, the decision to move into a family member’s home is made when a crisis develops or as a last resort. Sudden illness or injury strikes and the family is left without a plan for long-term care for their loved one. Experts suggest that all families discuss the possibility of the need for long-term care, and the possibility of family members living together as a solution to the daily care situation. The following are some items to discuss with all members of the family before making such a move.

Accessibility

Is the home “elder friendly”? It is necessary to review the setup of the home, in terms of stairs, additional bedrooms, bathrooms and general safety issues. If home modifications are needed, they should be completed prior to the move.

Care

How much care will the relative require? Daytime supervision, medication management, meal preparation and entertainment are just a few examples of important issues to consider. Assess the level of assistance needed now and in the foreseeable future. If the relative is in poor health, who will be in charge of providing the care? Will other family members share in the caregiving duties? Establish basic rules and a care routine to help prevent conflicts and caregiver burnout.

Emotions

How do family members get along with each other? How are conflicts dealt with? All families have their share of problems and each family handles them differently. The loss of independence is difficult for anyone and reactions or behavior change is to be expected. It is important to be able to talk about how everyone is feeling and encourage the relative to continue with a life of their own. Communication skills, including active listening, are necessary in handling and resolving conflicts successfully.

Finances

How will the change in household expenses be handled? An increase in family size usually means an increase in family expenses. Will the relative contribute? Are there other family members who can help with financial support?

Responsibilities

What is expected of the relative? What responsibilities will they have for care of the home? If there is a separate apartment, will everyone dine together? What about family outings – will the relative always be included?

Avoid the feeling that the situation is permanent.

Start with a limited “trial period,” then review the situation.

Once the move has been made to live together, it is very important for all family members to have continual open and honest communication with each other on all matters. Don’t hold in your feelings – both positive and negative feelings need to be shared.

If the health condition of the relative changes, and additional care is needed, it is crucial for the family to review the daily plan. If the situation requires help outside the family, there are a number of alternatives that the family and the relative can explore together. Make sure that the relative is included in decision making, if they are able. Some other options for care include: daily home health aide or homemaker care, which would also provide respite relief for family caregivers, home based community care programs, friends and neighbors, church outreach programs and dividing the care responsibilities among the family by rotating care, with the relative going to others’ homes, or by allowing other relatives to come into the home to provide the daily care.

Families who maintain open and honest communication and are willing to share in the financial and caregiver responsibilities for a needy relative can successfully reside together in the same home. Support can and should be a two-way street. Where better to get the daily support that we all need than from our family!

Contact a Geriatric Care Manager/Aging Life Care Professional™ www.rgcmgmt.com for a free 15 minutes telephonic consultation.

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Considerations for Caregivers

By Arthur N. Gottlieb

Caregiving is not for everyone. Remember, it’s not about you. If the relationship is too emotionally charged or patience is not your best virtue, find someone else to take over the primary role of caregiver.

It is important to reflect upon your motivations for being a caregiver and to make an honest assessment of your limitations.

As a caregiver you may at times feel powerless and sad. But an experience laden with difficulty may also provide opportunities to strengthen relationships with loved ones, and for the development of one’s own personal and spiritual growth.

About Visits
Focus on the quality of interactions with a loved one, not on the quantity.

Consistency and predictability of visitations are important, especially for the homebound.

Communication Skills
Learn the healer’s art of “bearing witness.” This means listening empathically and suppressing the urge to intervene with solutions.

When speaking to someone in bed or in a wheelchair, sit down or otherwise lower yourself so that you are at the same eye level as they are. This will distinguish you from others who remain standing, essentially looking and speaking down to them with the unspoken but inherent power differential this implies.

Choose your battles wisely. Attempting to address an irrational situation with rationality is generally futile, and will increase conflict with no resolution

The hearing impaired are often too prideful to admit that they haven’t heard most of what you just said, and are hopeful that they can eventually figure it out.

Those with mild cognitive impairment are still quite capable of comprehension, but the thought process may have slowed down a little. Be patient and speak slowly.

Restoring Dignity
Asking for a senior’s opinion about a non-provocative issue may offer them an opportunity to feel respected and still relevant.

At the dinner table when others are present, if a person needs to have their food cut for them, discreetly take the plate back into the kitchen and cut it there. This will add an unspoken but important element of dignity for those being cared for.

Residential and Financial Concerns
The attitudes and behaviors of many seniors are oftentimes driven by an unspoken fear of abandonment.

When parents do not feel that their children have made wise decisions for themselves, they are naturally hesitant to turn over financial control to them.

It was not uncommon for senior women to have deferred to their husbands’ judgment when choices were being made about financial and property issues. If now widowed, they may feel more comfortable acting in accordance with someone else’s say-so for important decision-making.

It may be illuminating to discover what memories a senior has of his or her own parent’s convalescence. What would they, as caregivers, have done differently? Had they promised themselves they would never go to a “nursing home”?

When a senior is facing the prospect of moving to a continuing care or assisted living community, speak to them about what they think this will be like. Many will have a stark vision of facilities from many years ago when options were relatively limited.

About Moodiness
Seniors will experience good days and bad days due to effects of pain, adjustment to medications and or emotional issues.

Seniors who seem short-tempered may be responding to the frustrating lack of control of not being able to think as quickly, and remember as well, as they once had.

Psychology of Seniors
Understand and be prepared to recognize the issues that trigger depression and anxiety for seniors.

Be sensitive to anniversary depressions. Birthdays, anniversaries, and major holidays evoke memories of those who have passed, and independence lost.

For most, losing control of physical functioning is difficult. Experiencing the steady loss of friends and relatives leads to sadness and isolation. For those with dementia, witnessing the gradual loss of one’s own self can be the ultimate loneliness.

If a senior is grieving the loss of a loved one they think died yesterday, even if that person actually died years ago, their grief will be as deep and painful as though it just happened.  This is legitimate suffering and must be handled with empathy.

Oftentimes, a parent will have a set of expectations of how they deserve to be treated by their children based on the sacrifices they made on behalf of their own parents. When children do not meet these expectations, resentment, depression and various forms of acting out behavior are the result.

Some seniors harbor lifelong prejudices that were carefully concealed. It can be quite distressing for a caregiver to discover that their parent has “all of a sudden” developed a shocking taste for racial bias. The gradual loss of mental functioning allows one to become “dis-inhibited”; thoughts, formerly suppressed due to social constraints, are now out in the open. This applies for latent sexual desires as well, especially for men.

Denial
If the person you are caring for continually puts off medical diagnosis, they are using the defense of denial in the service of their fear. If they are never diagnosed, then they never have to face the reality of being sick.

For Senior Men
More often than not, senior men went along with the social arrangements made by their wives. If a man becomes a widower, he may feel out of place socializing with others on his own. Additionally, since women outnumber men of this age group, a man may feel he is betraying the memory of his wife when engaging in social situations involving mostly women.

Religion and Spirituality
It is important to understand what a person’s religious or spiritual beliefs are. Does he or she believe in an afterlife? Are they concerned over what is in store for them when their mortal life ends? Are they disillusioned  or angry with God?

Restore and Maintain Balance
It is essential for you, as a caregiver, to leave time for your own introspection and emotional balance. Engage in activities that serve to cleanse toxins and stress from the body and spirit.

Engage the help of others when necessary to de-stress and achieve perspective.

Rest and relaxation are critical in order to prevent “caregiver burnout.”

Raleigh Geriatric Care Management Aging Life Care Professional  www.rgcmgmt.com

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Geriatric Care Manager—>Aging Life Care Professional

WHAT IS AN AGING LIFE CARE PROFESSIONAL?

An Aging Life Care Professional, also known as a geriatric care manager, is a health and human services specialist who acts as a guide and advocate for families who are caring for older relatives or disabled adults. The Aging Life Care Professional is educated and experienced in any of several fields related to aging life care / care management, including, but not limited to nursing, gerontology, social work, or psychology, with a specialized focus on issues related to aging and elder care.

The Aging Life Care Professional assists clients in attaining their maximum functional potential. The individual’s independence is encouraged, while safety and security concerns are also addressed. Aging Life Care Professionals are able to address a broad range of issues related to the well-being of their client. They also have extensive knowledge about the costs, quality, and availability of resources in their communities.

Aging Life Care Professionals become the “coach” and families or clients the “team captain,” giving families the time to focus on relationships rather than the stress. In Raleigh, Durham, and surrounding area, contact Raleigh Geriatric Care Management, an Aging Life Care member.


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Caregiver Burnout

By Dr. M. Ross Seligson

Being able to cope with the strains and stresses of being a Caregiver is part of the art of Caregiving In order to remain healthy so that we can continue to be Caregivers, we must be able to see our own limitations and learn to care for ourselves as well as others.

It is important for all of us to make the effort to recognize the signs of burnout, In order to do this we must be honest and willing to hear feedback from those around us. This is especially important for those caring for family or friends. Too often Caregivers who are not closely associated with the healthcare profession get overlooked and lost in the commotion of medical emergencies and procedures. Otherwise close friends begin to grow distant, and eventually the Caregiver is alone without a support structure. We must allow those who do care for us, who are interested enough to say something, to tell us about our behavior, a noticed decrease in energy or mood changes.

Burnout isn’t like a cold. You don’t always notice it when you are in its clutches. Very much like Post Traumatic Stress Syndrome, the symptoms of burnout can begin surfacing months after a traumatic episode. The following are symptoms we might notice in ourselves, or others might say they see in us. Think about what is being said, and consider the possibility of burnout.

  • Feelings of depression.
  • A sense of ongoing and constant fatigue.
  • Decreasing interest in work.
  • Decrease in work production.
  • Withdrawal from social contacts.
  • Increase in use of stimulants and alcohol.
  • Increasing fear of death.
  • Change in eating patterns.
  • Feelings of helplessness.

Strategies to ward off or cope with burnout are important. To counteract burnout, the following specific strategies are recommended

  • Participate in a support network.
  • Consult with professionals to explore burnout issues.
  • Attend a support group to receive feedback and coping strategies.
  • Vary the focus of caregiving responsibilities if possible (rotate responsibilities with family members).
  • Exercise daily and maintain a healthy diet.
  • Establish “quiet time” for meditation.
  • Get a weekly massage
  • Stay involved in hobbies.

By acknowledging the reality that being a Caregiver is filled with stress and anxiety, and understanding the potential for burnout, Caregivers can be forewarned and guard against this debilitating condition. As much as it is said, it can still not be said too often, the best way to be an effective Caregiver is to take care of yourself.

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Laughter is the Best Medicine

By  Helen Hunter, ACSW, LSW

When was the last time you had a really good laugh?

The scientific definition of laughing is a “successive, rhythmic, spasmodic expiration with open glottis and vibration of the vocal cords, often accompanied by baring of the teeth and facial expression”. That doesn’t begin to tell the story of what laughing does for us, however. The bottom line is that laughing is medically beneficial.

Laughter establishes or restores a positive emotional climate and a sense of connection between two people. In fact, some researchers believe that the major function of laughter is to bring people together – the more social a person is and the more social support a person receives, the more likely that laughter will result from that social connection. Mutual laughter and play are an essential component of strong, healthy relationships. By making a conscious effort to incorporate more humor and play into your daily interactions, you can improve the quality of your relationships.

What are the Physical Effects of Laughing?

Laughing makes people feel good for a reason. Studies have shown that laughter boosts the immune system and triggers the release of pleasure-inducing neurochemicals in the brain. The immune system, which contains special cells that are responsible for defending the body against infection, have been shown to increase during the act of laughing. In the central nervous system, the brain releases powerful endorphins as a result of laughing. Endorphins are natural, morphine-like compounds that raise the pain threshold, produce sedation and induce euphoria (commonly called a “natural high”). In other words, we feel better when we laugh because endorphins reduce physical and mental pain. While this may be a wonderful feeling, laughing has other benefits as well:

During a laugh, respiration, heart rate and blood pressure temporarily rise. This causes oxygen to surge through the bloodstream that then results in lower blood pressure.

Laughter improves the function of blood vessels and increases blood flow, which can help protect against a heart attack and other cardiovascular problems.

Laughter reduces pain and allows toleration of discomfort.

Laughter reduces blood sugar levels, increasing glucose tolerance in diabetics and non-diabetics alike.

Laughter relaxes the whole body, relieving tension and stress. It has been shown that following a good, hearty laugh, muscles in the body are relaxed for up to 45 minutes afterward.

Laughing burns calories – laughter is sometimes referred to as “inner jogging”. A hearty laugh gives the muscles of the face, chest, shoulders, stomach and diaphragm a good workout.

Laughter also helps to create a positive mood. It allows the expression of happiness and the release of anxiety. Humor eases tension and is a great antidote to a stressful situation. Laughter is often seen as a temporary vacation from everyday problems, bringing us to a paradise in which worries do not exist. Humor and laughter are natural safety valves that shut off certain hormones that are released during stressful situations. In fact, your sense of humor is one of the most powerful tools you have to make certain that your daily mood and emotional state support good health.

Here are some ways to bring more humor and laughter into your life:

Smile: Smiling is the beginning of laughter. Like laughter, it’s contagious. When you look at someone or see something even mildly pleasing, practice smiling!

Count your blessings: Literally make a list. The simple act of considering the good things in your life will distance you from negative thoughts that are a barrier to humor and laughter!

When you hear laughter, move toward it: People are very happy to share something funny because it gives them an opportunity to laugh again and feel the humor in it. When individuals hear laughter, they seek it out and ask “What’s funny?”

Spend time with fun, playful people: These are people who laugh easily, both at themselves and at life’s absurdities and who routinely find humor in everyday events. Their playful point of view and laughter are contagious!!

Bring humor into conversations: Ask people: What’s the funniest thing that happened to you today? This week? In your life?

Laugh at yourself: Share your embarrassing moments.

Attempt to laugh at situations rather than bemoan them: Look for the humor in a bad situation, the irony and absurdity of life. This will help improve your mood and the mood of those around you.

Surround yourself with reminders to lighten up: Keep a toy on your desk or in your car. Put up a funny poster in your office. Choose a computer screensaver that makes you laugh. Frame photos of you and your family having fun.

Keep things in perspective: Many things are beyond our control, so make the best of a situation and find the positive in the situation.

Deal with stress: Stress is major impediment to humor and laughter.

Pay attention to children and emulate them: They are the experts on playing, taking life lightly and laughing!!

Here is a simple prescription for a healthy life:

Thirty minutes of exercise at least 3 times a week, and 15 minutes of laughter on a daily basis!!

The bottom line – laughter may just be the best medicine on the market today!

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Filed under adult children of aging parents, Alzheimer's Disease, anxiety and the elderly, assessments, care giving, care planning, caregiver burnout, caregiving, caregiving and the holidays, dementia, Depression and the elderly, elder care raleigh nc, employee stress, family meetings, Geriatric Care Management, Having a conversation, humor, laughter in caregiving, long term care planning, moving in with family, NC, Raleigh, respite, Sandwich Generation, senior care, sibling relationships, support groups

Long Distance Caregiving

Carol O’dell

If you’re a long-distance caregiver, then you know the drill. You call all the time. You coordinate care from 400 miles away. You spend long weekends or vacation time visiting your loved one and hoping before you open that door that they’re OK. Worry comes with long-distance caregiving, and so does guilt, but you try really hard to make it work — and you dread the day that won’t be enough.

You are not alone. According to a recent Caring.com poll, nearly one-third of all caregivers do not live with or, in many cases, even near their loved ones. Here’s a look at a few challenges long-distance caregivers face, and tips to help manage care from afar.

Feeling emotionally connected to your family members.

Sometimes phone calls or visits filled with doctor appointments and home chores don’t allow for heart-to-heart talks. As much as there is to cover, make the time to just sit for a few minutes and allow a natural conversation to emerge.

Set up a weekly phone-chat date for the times that you’re apart. Have it at a time when you both can look forward to it and nothing competes. After you discuss some of your “to-do” list items, begin to share something personal about your own life. Ask their advice on something — anything — from the color shoes you should wear to your cousin’s wedding to whether you should get a bigger car. Let them feel as if they’re a part of your life as well.

Getting shut out.

Many long-distance caregivers, particularly those helping someone with moderate to severe dementia, find that their visits actually aggravate their loved ones — who are confused and want to “go home” or don’t understand why you keep calling them “Dad.”

Remind yourself that you’re not just there to visit. You’re there to make sure Mom or Dad are being cared for properly. (Having a loved one with moderate to severe dementia increases the likelihood that he or she is living in a care facility.) Stay out of sight if you have to, but visit the staff, have lunch in the cafeteria, and walk the grounds. Talk to the people your loved one interacts with to find out how he or she is doing. It’s painful not to be able to connect, but remember that you’re still needed.

Knowing your loved one is safe and appropriately cared for.

Audrey Adelson, author of “Long-Distance Caregiving,” writes, “Often, long-distance caregivers obtain important information from their elder or secondhand from family members who have spoken with a member of their loved one’s treatment team. This makes it difficult to get a clear understanding of what is really going on.” How do you stay in the loop when you’re not in the area?

How to manage? By having lots of eyes. Whether you coordinate care for your loved one in his or her home or an assisted living facility, start to connect with those who interact with your loved one. Call after an appointment and ask how it went. Let them know you plan to be involved, and be sure to send a thank-you card or friendly e-mail.

Managing insurance and financial needs or making sure you can trust those who do.

Trust is a big issue for long-distance caregivers. When you don’t have people who genuinely care for your loved one and communicate with you about what’s going on, then you begin to worry, and worry, and worry.

Take the time to find professionals who can assist you and your loved one. It’s worth the time and effort. Hire an elder law attorney to make sure their financial assets are protected, or check into local resources designed for seniors and their family’s needs.

Make a plan for whatever comes next.

Long-distance caregivers dread getting “the call.” Whether it’s from a concerned neighbor or from the ER at 4 a.m., it’s difficult to know what to plan for when anything could happen. Try to laugh (or scream, or sob) when all of your planning and hard work takes a dive and you have to come up with a new plan. Change is inevitable, and when we fight that it that causes us pain.

Play “what if.” Come up with the three possible scenarios — a fall, a worsening of a condition or ailment, or a refusal to move even when that’s needed. How will you handle it? Can you go ahead and do some online searches? Can you connect with other caregivers and ask how they handled a big change and ask how it’s going now? It’s easier to face the “what ifs” when you know that somehow, some way, you will get through.

Being a long-distance caregiver comes with challenges you never thought you’d have to face. Sometimes you have to let go, just a little, of all that you can’t control. Caregiving isn’t easy, and there aren’t always solutions, so grab your rearview mirror the next time you’re in your car and look at yourself and say, “You’re doing the best you can.”

For a loved one living in Raleigh, NC, contact Raleigh Geriatric Care Management to assist with your family member. www.rgcmgmt.comRaleigh ,NC

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A sibling’s guide to caring for aging parents

BY BONNIE LAWRENCE

Caring for an aging parent alone is complicated. When your brothers and sisters are also involved, and when care, medical and financial decisions must be arrived at together as a team, caregiving can become even more complex. Your siblings can be enormously helpful and your best support. But in many families, they can also be a source of stress. No two families are ever alike.

In this column, we’ll talk about how to identify the family dynamics that can impact shared caregiving, ways your siblings can help, how to increase your chances of getting that help, and how to deal with emotions that arise.

A visit home. Often, around this time of year, adult children returning home for a visit realize for the first time that their parents are far more frail than they expected. Although Mom or Dad always report they are “just fine” when you make those weekly phone calls, during a visit, you realize that this is not the case. Your parents suddenly seem much older, and you see the memory lapses, or shortness of breath, wavering balance, multiple prescription containers, or other signals of waning health.

Reactions differ among your siblings. Perhaps your sister, who lives two hours away, is angry that her mother is not the source of emotional support she used to be and doesn’t want to accept what she sees; your brother, who lives across the country and only gets home once a year, is stunned by changes he didn’t expect.

You and your siblings talk in whispers about what should to be done to ensure Mom’s safety and care. There is no money for assisted living, even if your mother would agree to it. Someone needs to step up, to see what can be done, to make decisions, to find some help, or even to live with your Mom to keep her as safe and healthy as possible. And it’s determined, often by default, that one person — perhaps the one who lives the closest, or doesn’t have kids, or is the oldest — will take on the role of primary caregiver.

Why sibling tensions can surface as parents need care

People are living longer — but not necessarily in good health. Their adult children may be caring for them for years or even a decade or more. Siblings or step-siblings are coping with a major emotional passage that stirs up childhood feelings and conflicts. But it’s made more challenging when there’s no model for working together as a team to handle the practical, emotional and financial issues that go with caring for someone who is no longer able to be independent. Some families are able to work out differences; many others struggle.

Consciously or unconsciously, needs arise for love, approval, or being seen as important or competent as a sibling. The disagreements now are over care for your parent: who does or doesn’t do it; how much; who’s in charge. At the same time, your parent is very aware — and most likely not happy — that he or she has become so dependent on you.

To help your family navigate through this situation, we offer this advice:

1. Think about, and talk about, family history and dynamics, and how they might affect caregiving. When we get together with our families, many of us tend to slip into our old roles. Maybe one person was the “responsible” one, one was the “social” one, one was the “helpless” one. But do those roles define you today? And more importantly, can you take a fresh look at who your siblings are now in the context of how these roles and assumptions can affect care for your parents?

2. Consider that care for a parent is a shared responsibility. A key concern is who will be the primary care provider(s) and what support other family members can provide. Since this is a role that can progress to more than a full-time job, this is an important decision. Rather than letting assumptions become default decisions (e.g., Barbara is oldest so she will be in charge, or Max needs a place to stay, so he’ll take care of mom), really consider who is most able, willing, skilled, and emotionally prepared to fill this role. Then consider what other family members can contribute in time or money.

3. To help reach the goal of effective shared decision-making, hold a family meeting. Family meetings are a way for siblings, parents and other concerned relatives or friends to try to clarify the situation, work out conflicts and set up a care plan that, ideally, all can agree upon. If the meeting is likely to be contentious, or if you want an experienced, objective voice to guide it, involve a facilitator such as a social worker, counselor, geriatric care manager or trusted outside party who will ensure that all participants have a chance to be heard. You may need more than one meeting. And although emotions might run high, it’s possible to conduct a productive meeting by following a few guidelines:

  • Set an agenda for the meeting and keep to it.
  • Focus on the here and now. Try not to bring up past or unrelated issues.
  • Share your feelings with siblings instead of making accusations.
  • Listen and respect the opinions of all participants. Give everyone time to speak.
  • Share all information. If possible, get a professional assessment of your parent’s condition from a doctor, social worker or geriatric care manager and send the report to all participants before the meeting.
  • As time goes by, use email, online care-sharing tools, conference calling and/or in-person family meetings to help keep everyone abreast of care issues and information.4. Understand and respect that your brothers and sisters might have different ideas about the care your parent needs. It’s hard to accept that your parent now need your help. Unless there’s a sudden crisis like a stroke, adjusting to this new reality takes time. Some adult children have to work through their denial that anything serious is wrong. Others might feel reluctant to get involved, fearing they are “meddling” in their parent’s life.

    Yet, to the primary caregiver, the person who is present day-to-day, it’s clear that his or her parent is less and less able to handle everyday needs. They see that Mom requires assistance with grocery shopping and cooking, that transportation and bill paying are problems, or advancing memory loss or fading eyesight or painful joints keep her from normal activities. Her needs are evident and most likely will become more intense.

    Working through differences: communication plays a critical role.

  • If you’ve held family meetings, everyone concerned should have a clear idea of the medical status of your parent. Focus on the facts.
  • REALLY listen to what your siblings have to say. Be willing to compromise and to try new solutions, as long as no one’s safety is jeopardized.
  • For the doubters, it may be helpful for them to spend a weekend or even a day as a sole caregiver, to get a first-hand view of the issues.
  • Be straightforward about financial issues. Finances are a key component in long-term caregiving, affecting where your parent lives, whether paid outside help is available, whether placement in a facility is a suitable or desirable option, or whether home care is manageable with family support. Overseeing bill-paying and dealing with Medicare and other health care bills is a job in itself, and can be delegated as such.
  • Let your siblings know that their help is needed and wanted (if, in fact, it is — see below). Be direct and specific about what tasks you need help with. Even if they live far away, siblings can help with finances, can provide virtual companionship to your parent with frequent phone calls and Skype, or can provide occasional respite or substitute care.
  • Keep communication lines open.

Tips for gaining the support of your siblings

  • Accept your siblings for who they are. Not everyone thinks, feels or acts the same way, especially when a situation is this emotionally charged. Try to keep your own expectations and expressions of “should” in check, and instead, strive to accept and work with your siblings’ personalities and abilities.
  • Be aware of how you ask for help. If you’re angry and frustrated when you’re talking with your siblings, it will come through in your voice. Their reaction will be defensiveness or anger. Likewise, making siblings feel guilty may lead to resentment and tension that will not be productive in solving the problems at hand.
  • Figure out what you really expect from your siblings. Do you think they should provide more hands-on care? Help with errands? Visits? A day or week of respite? Financial support? Help with decision-making? Analyze whether you’re able to give up control to allow a sibling to help you, or if you’re unconsciously communicating that you don’t trust the care that someone else provides.Some caregivers really don’t want help, or can’t rely on help from siblings who are undependable or unavailable. If you’re in this situation, admit it to yourself, accept that you’re on your own, and work to make the care as efficient as possible while still attending to your own health and well-being. If other relatives or friends are willing, ask for help from them or from religious communities your parent might have been involved in. Check for resources in your community. When people offer to help, say yes.
  • If what you really want is recognition and appreciation from your siblings for all that you do, you can ask for that. (You also need to express your own gratitude when you do get some help.)
  • Seek advice from someone outside the family. A mediator, social worker or geriatric care manager may help get past long-standing emotional roadblocks, family competition, controlling behavior, denial, or other issues interfering with successful resolutions.

Conflicts over legal, financial and inheritance issues.

With Durable Powers of Attorney or an Advance Health Care Directive, your parents can designate who will be in charge if they become incapacitated. Sometimes this creates tension among the adult children. If at all possible, this should be discussed at a family meeting and clarified for everyone concerned. An advance directive will outline the types of care that your parent desires at end of life. With this information in writing, a difficult situation is made a little more tolerable.

Some families compensate the primary caregiver for their work, particularly if he or she has cut back on employment to care for their parent. How much the compensation is and who pays it can be covered in a Personal Care Agreement, which is a written contract. This can be reviewed periodically to ensure it reflects any changes in care.

If an inheritance is in question, or if someone feels they should get a larger portion of an inheritance because of their caregiving duties or other reasons, this is another source of potential conflict. Be aware that your parent’s will is his or hers to direct as they like, and is not necessarily representative of who was the “good” son or daughter or who did more or less for their parents.

Sharing care among siblings is a reality that millions of Americans manage on a daily basis. By taking steps to foster positive communication and support one another as much as possible, the challenging role of providing care for elderly parents can be a fulfilling, rewarding experience, which ultimately can bring siblings closer together.

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Stress and the Holidays: Coping Strategies to Keep you Sane

By Helen Hunter,

Every year, the media bombards us with advertisements showing the “happy family” gathering for the holidays. People from different generations are together, having a wonderful time, sharing traditions of old and creating new ones as well.

It is not that way, though, for a great number of individuals. For those who don’t have families of their own, or for those who live alone and have relatives living far away, holidays often bring heartbreak and depression. Those who have been used to family celebrations in the past and no longer have that to look forward to cannot accept the “change” in the tradition, especially if they keep hearing about others who are getting together with their own families.

There are two things to remember that can help get you through the holidays. The first thing to realize is that it is okay to cry. This can be a tough time for many. It is natural to feel depressed when your friends are having the ideal family gathering. Allow yourself to express your inner feelings.

The second thing to remember is to control the holidays, do not let them control you. This requires planning. If you know that you will be alone on the holiday, start planning ahead for what you will do. Here are some suggestions for things you can do to sidestep the holiday blues:

  1.  If you cannot be with family, try to spend time with friends or neighbors instead.
  2. Get away from the source of the depression. If your home reminds you of past holidays spent with a loved one, go on a cruise, or take a vacation to another part of the country, or go abroad.
  3. Get involved with an activity. Volunteer at a local senior center, church or community center that serves meals on the holiday, or give your services to a hospital. If you know that someone will be alone and cannot get out for the holiday, visit. If the person lives far away and you cannot physically visit, make a phone call. In helping those who are less fortunate than yourself, you can forget some of your own troubles.
  4. Invite others who are also alone to your home to share the holiday. You can prepare a meal for them, or you can go out to a restaurant. Company always helps ease depression.

Be gentle to yourself, especially if you have recently lost a loved one. If you do not feel like celebrating, don’t! If you do wish to celebrate, keep it simple. Remember the TRUE reason that we celebrate the holidays!

The important point to remember here is that if the old traditions cause heartbreak and depression, change the tradition – start a new one!

Also, be sure to review your expectations and be realistic. Not everyone is jolly, generous and loving all through the holiday season. As Wayne A. Van Kampen from the Bethesda PsycHealth Reporter wrote, “ Somehow (during the holidays) persons feel pushed into hiding, covering over, or denying the reality of sadness, fear and tension. Perhaps what is needed most is simply a more honest embracing of ourselves, others, and the realities of life.” Not everyone will have a happy family gathering just because it is the holiday season. Old resentments are likely to resurface, no matter how hard we try, when people are thrown together for an extended period.

In addition, there are a number of strategies that can be used in planning the holiday celebration.

These strategies include the following:

  • Delegate responsibilities and activities so that one person is not taking on more than can be accomplished without help.
  • Do not assume responsibility for the entire household’s holiday happiness.
  • Work minute by minute on your attitude. Postpone becoming angry and show understanding and calmness. This technique should be used not only during the holiday period, but every day!
  • Any task that you have chosen to do, whether it be the cooking, cleaning, gift wrapping, card addressing, organizing, decorating or shopping, is to be viewed as a choice that you made. Try to have fun in tackling these tasks, which will make the holiday easier and keep your spirits positive.
  • Start traditions that make the most sense to you in your life now. It doesn’t always have to be done the same way every year.
  • Do things together as a family that you all truly enjoy.

Make the holiday season a time for you and your loved ones to have fun and to share special memories. When the entire season is over, sit down, relax and count your blessings. Remind yourself as to how lucky you are. When you make an effort to have a joyous, stress-free holiday, you can avoid the stress. The key is to plan ahead, and to ask for and accept help from others.

Raleigh Geriatric Care Management www.rgcmgmt.com

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